Individual
WALTER L WYNNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2131 W 3RD ST, ST VINCENT MEDICAL CENTER, LOS ANGELES, CA 90057-1901
(310) 874-0623
Mailing address
201 WILSHIRE BLVD, STE A26, SANTA MONICA, CA 90401-1212
(310) 874-0623
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
A043607
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A043607
STATE LICENSE
CA
Enumeration date
05/16/2006
Last updated
05/13/2010
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